Clinical Features

Although any body part or aspect of physical appearance may be a source of concern and several body parts may be involved simultaneously, concerns generally focus on the patient's face or head (e.g., size or shape of the nose, eyes, lips, teeth, or other facial features; thinning hair; excessive facial hair; acne; wrinkles; scars). Individuals may spend hours per day checking their appearance, engage in excessive grooming or exercising to minimize or erase the defect, and/or become housebound.

BDD has much in common with OCD. Both disorders are characterized by the presence of intrusive thoughts and repetitive behaviors, as well as the per-severative need to seek reassurance. According to DSM-IV-TR, however, the obsessions and compul-

Table 8-4. DSM-IV diagnostic criteria for body dysmorphic disorder

A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).

sions of patients with OCD are not restricted to concerns about physical appearance. Those individuals with BDD who are successful in obtaining surgery may continue to be concerned about the perceived defect or may shift the focus of attention to other aspects of their appearance (Phillips 1991).

Substantial comorbidity exists between BDD and depression, OCD, social phobia, delusional disorder, anorexia nervosa, gender identity disorder, and narcissistic personality disorder. Kaplan et al. (1994) reported that 20% of patients with BDD have attempted suicide, whereas 22%-29% of patients with a history of child maltreatment have attempted suicide. Didie et al. (2006) found that nearly 79% of 75 subjects with BDD reported a history of childhood maltreatment, such as physical, sexual, and emotional abuse or physical neglect.

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.